Treatment and prognosis of hepatocellular carcinoma: a population based study in France.
OBJECTIVE
Few data are available from population-based statistics on hepatocellular carcinoma (HCC). The aim of this study was to report on their management and their prognosis in a French population.


METHODS
Between 1997 and 1998, 1,007 cases of HCC were registered in nine French departments: clinical presentation of patients with and without cirrhosis were compared as well as treatment. Prognosis was determined using crude and relative survival rates. A multivariate relative survival analysis was performed. HCC was associated with cirrhosis in 795 patients (79%) and to the absence of cirrhosis in 156 (15%).


RESULTS
Whereas the presence of symptoms was the principal mode of discovery (63% of cirrhotic cases and 70% of non-cirrhotic cases), the follow-up of hepatic affections revealed the cancer in respectively 26% and 3% (P = 0.001). The diagnosis was histologically verified in 50% of cirrhotic patients and 80% of non-cirrhotic patients (P = 0.01). The size of tumours was significantly greater in non-cirrhotic than in cirrhotic cases (P = 0.004). Treatment for cure were implemented in respectively 15% and 30% (P = 0.001), resulting in 5-year survival rates of respectively 34% and 28%. Only 24 HCC cases received a liver transplant, with a 5-year survival rate of 60%. Surgical resection for cure was carried out in respectively 10% and 31% of HCC and HCNC cases (P = 0.001), with a 5-year survival rate of respectively 39% and 29%. The overall 5-year survival rates of HCC and HCNC were respectively 6% and 9%.


CONCLUSIONS
HCC with and without cirrhosis has a poor prognosis with the majority of patients receiving palliative treatments, the efficiency of which is very limited. Considerable efforts are needed to develop primary and secondary prevention.
Borie
Frédéric
F
Registre des Tumeurs de l'Hérault, Centre de Recherche, Montpellier Cedex, France. fborie@yahoo.com
Bouvier
Anne-Marie
AM
Herrero
Astrid
A
Faivre
Jean
J
Launoy
Guy
G
Delafosse
Patricia
P
Velten
Michel
M
Buemi
Antoine
A
Peng
Jun
J
Grosclaude
Pascale
P
Trétarre
Brigitte
B
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D005602:France / Q000453:epidemiology; D006498:Hepatectomy; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D007459:Iodized Oil / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D010166:Palliative Care; D011379:Prognosis; D016499:Radioimmunotherapy; D012042:Registries; D013629:Tamoxifen / Q000627:therapeutic use
D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D007457:Iodine Radioisotopes; D013629:Tamoxifen; D007459:Iodized Oil